Abstract
The subject of this randomised controlled trial is cervical cancer, which is the sixth most common malignancy. Treatment can involve surgery, radiation and/or chemotherapy. Cancer pain can become very acute during treatments. Therefore, optimising pain control including timely treatment of side-effects is vitally important to avoid morbidity and chronic pain and to improve the patients’ quality of life.
This small study was designed to investigate the effects of adding a music relaxation video to standard pain management treatment for patients undergoing intracavitary brachytherapy. Patients were randomised to view a music relaxation video four times during the first 44 hours of treatment.
The authors provide an interesting and informative description of both gynaecological cancers and brachytherapy in the introduction, which is helpful for the nonspecialist. There were several methodological challenges faced by the authors in the design and execution of their study, including the lack of blinding and lower than planned recruitment. There was a significant difference in ages between the control and intervention groups, and several of the patients were admitted with high baseline pain scores. In addition, patients were taking other medications such as anxiolytics. This perhaps reflects the real life challenges of conducting research with limited time and resources, and the authors are to be commended for completing the study and sharing their results.
The difference in pain scores between the two groups reach statistical significance, but it is debatable whether they are clinically significant. The opioid requirements, via patient-controlled analgesia (PCA) devices, were also reduced. It was not reported if there was a corresponding lowering of opioid-related side-effects. It can be particularly difficult to interpret opioid consumption in pain studies, particularly when the patients are taking a variety of other medications. There is also a debate in the literature about the problems of analysing opioid consumption via a PCA and pain scores separately, as this could result in a decrease in effect size and increase the possibility of false positive findings (Dai et al., 2013). Nevertheless, the results of this trial are encouraging.
We already know that nonpharmacological interventions are very important adjuncts for controlling pain. A Cochrane review, published in 2006, concluded that listening to music for treatment of pain reduced pain intensity and opioid requirements after surgery, but that the magnitude of benefit was small (Cepeda et al., 2006). This pragmatic study makes a useful contribution to a complex topic despite the low recruitment. Effective pain relief and individualised care is particularly important to reduce the anticipatory stress prior to repeated procedures or interventions.
The music and images will not replace the requirement for a multimodal analgesic approach to pain relief for patients undergoing this unpleasant and painful procedure, but offers additional strategies which should be relatively easy to implement, have no side-effects and are relatively cheap. The findings will be applicable to other settings where patients are undergoing stressful procedures, both in hospital and in the community. There is definitely scope for designing a larger multicentre trial, including a cost-effectiveness analysis, for exploring this topic further. I would encourage the inclusion of side-effects and quality of life outcome measures in future study designs.